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DEMYELINATING DISEASES Nurse Licensure Examination Review pinoynursing.webkotoh.com

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MULTIPLE SCLEROSIS <ul><li>An auto-immune mediated progressive demyelinating disease of the CNS </li></ul><ul><li>The myelin sheath is destroyed and replaced by sclerotic tissue (sclerosis) </li></ul>

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MULTIPLE SCLEROSIS <ul><li>CAUSE- unknown </li></ul><ul><li>Multiple factors- viral infection, environmental factors,geographic location and genetic predisposition </li></ul><ul><li>Common in WOMEN ages 20-40 </li></ul>

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MULTIPLE SCLEROSIS <ul><li>PATHOPHYSIOLOGY </li></ul><ul><li>Sensitized T cells will enter the brain and promote antibody production that damages the myelin sheath </li></ul><ul><li>Plaques of sclerotic tissues appear on the demyelinated axons interrupting the neuronal transmission </li></ul>

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MULTIPLE SCLEROSIS <ul><li>PATHOPHYSIOLOGY </li></ul><ul><li>The most common areas affected are </li></ul><ul><ul><li>Optic nerves and chiasm </li></ul></ul><ul><ul><li>Cerebrum </li></ul></ul><ul><ul><li>Cerebellum </li></ul></ul><ul><ul><li>Spinal cord </li></ul></ul>

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MULTIPLE SCLEROSIS <ul><li>CLINICAL MANIFESTATIONS </li></ul><ul><li>1. visual problems such as diplopia, blurred vision and nystagmus </li></ul><ul><li>2. motor dysfunction </li></ul><ul><li>3. Fatigue </li></ul><ul><li>4. Mental changes like mood swings, depression </li></ul><ul><li>5. spasticity </li></ul>

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MULTIPLE SCLEROSIS <ul><li>DIAGNOSTIC TESTS </li></ul><ul><li>1. MRI- primary diagnostic study </li></ul><ul><li>2. CSF Immunoglobulin G </li></ul>

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MULTIPLE SCLEROSIS <ul><li>NURSING INTERVENTIONS </li></ul><ul><li>1. Promote physical mobility </li></ul><ul><li>Exercise </li></ul><ul><li>Schedule activity and rest periods </li></ul><ul><li>Warm packs over the spastic area </li></ul><ul><li>Swimming and cycling are very useful </li></ul>

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MULTIPLE SCLEROSIS <ul><li>NURSING INTERVENTIONS </li></ul><ul><li>2. Prevent injuries </li></ul><ul><li>Wide stance walking </li></ul><ul><li>Use of walking aids </li></ul><ul><li>Wheelchair </li></ul>

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MULTIPLE SCLEROSIS <ul><li>3. Enhance bladder and bowel control </li></ul><ul><li>Set a voiding schedule </li></ul><ul><li>Intermittent bladder catheterization </li></ul><ul><li>Use of condom catheter </li></ul><ul><li>Adequate fluids, dietary fibers and bowel training program </li></ul>

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MULTIPLE SCLEROSIS <ul><li>4 . Manage speech and swallowing difficulties </li></ul><ul><li>Careful feeding, proper positioning, suction machine availability </li></ul><ul><li>Speech therapist </li></ul>

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MULTIPLE SCLEROSIS <ul><li>5. Improve Sensory and Cognitive function </li></ul><ul><li>Vision- use eye patch for diplopia </li></ul><ul><li>Obtain large printed reading materials </li></ul><ul><li>Offer emotional support </li></ul><ul><li>Involve the family in the care </li></ul>

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MULTIPLE SCLEROSIS <ul><li>6. Strengthen coping mechanism </li></ul><ul><li>Alleviate the stress </li></ul><ul><li>Referral to the appropriate agencies </li></ul>

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MULTIPLE SCLEROSIS <ul><li>7. improve self-care abilities </li></ul><ul><li>Modify activities according to physical strength </li></ul><ul><li>Provide assistive devices </li></ul>

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MULTIPLE SCLEROSIS <ul><li>8. promote sexual functioning </li></ul><ul><li>Refer to sexual counselor </li></ul>

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MULTIPLE SCLEROSIS <ul><li>MEDICAL MANAGEMENT </li></ul><ul><li>Pharmacotherapy </li></ul><ul><ul><li>Interferons </li></ul></ul><ul><ul><li>Immunomodulators </li></ul></ul><ul><ul><li>Corticosteroids </li></ul></ul><ul><ul><li>BACLOFEN for muscle spasms </li></ul></ul><ul><ul><li>NSAIDS for pain </li></ul></ul>

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Guillian-Barre’ Syndrome <ul><li>An auto-immune attack of the peripheral nerve myelin </li></ul><ul><li>Acute, rapid segmental demyelination of peripheral nerves and some cranial nerves </li></ul>

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Guillian-Barre’ Syndrome <ul><li>CAUSE: post-infectious polyneuritis of unknown origin commonly follows viral infection </li></ul>

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Guillian-Barre’ Syndrome <ul><li>PATHOPHYSIOLOGY </li></ul><ul><ul><li>Cell-mediated imune attack to the myelin sheath of the peripheral nerves </li></ul></ul><ul><ul><li>Infectious agent may elicit antibody production that can also destroy the myelin sheath </li></ul></ul>

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Guillian-Barre’ Syndrome <ul><li>CLINICAL MANIFESTATIONS </li></ul><ul><li>1. Ascending weakness and paralysis </li></ul><ul><li>2. diminished reflexes of the lower extremities </li></ul><ul><li>3. paresthesia </li></ul><ul><li>4. potential respiratory failure </li></ul>

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Guillian-Barre’ Syndrome <ul><li>NURSING INTERVENTIONS </li></ul><ul><li>Maintain respiratory function </li></ul><ul><li>Chest physiotherapy and incentive spirometry </li></ul><ul><li>Mechanical vetnilator </li></ul>

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Guillian-Barre’ Syndrome <ul><li>NURSING INTERVENTIONS </li></ul><ul><li>2. Enhance physical mobility </li></ul><ul><ul><li>Support paralyzed extremities </li></ul></ul><ul><ul><li>Provide passive range of motion exercise </li></ul></ul><ul><ul><li>Prevent DVT and pulmonary embolism </li></ul></ul><ul><ul><li>Padding over bony prominences </li></ul></ul>

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Guillian-Barre’ Syndrome <ul><li>NURSING INTERVENTIONS </li></ul><ul><li>3. Provide adequate nutrition </li></ul><ul><ul><li>IVF </li></ul></ul><ul><ul><li>Parenteral nutrition </li></ul></ul><ul><ul><li>Assess frequently return o gag refelx </li></ul></ul>

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Guillian-Barre’ Syndrome <ul><li>NURSING INTERVENTIONS </li></ul><ul><li>4. Improve communication </li></ul><ul><ul><li>Use other means of communication </li></ul></ul>

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Guillian-Barre’ Syndrome <ul><li>NURSING INTERVENTIONS </li></ul><ul><li>5. Decrease fear and anxiety </li></ul><ul><ul><li>Provide Referrals </li></ul></ul><ul><ul><li>Answer questions </li></ul></ul><ul><ul><li>Provide diversional activities </li></ul></ul><ul><li>6. Monitor and manage complications </li></ul><ul><ul><li>DVT, Urinary retention, pulmonary embolism, respiratory failure </li></ul></ul>

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Guillian-Barre’ Syndrome <ul><li>MEDICAL MANAGEMENT </li></ul><ul><li>ICU admission </li></ul><ul><li>Mechanical Ventilation </li></ul><ul><li>TPN and IVF </li></ul><ul><li>PLASMAPHERESIS </li></ul><ul><li>IV IMMUNOGLOBULIN </li></ul>

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ALZHEIMER’S disease <ul><li>A progressive neurologic disorder that affects the brain resulting in cognitive impairments </li></ul>

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ALZHEIMER’S disease <ul><li>CAUSES: </li></ul><ul><li>Unknown </li></ul><ul><li>Potential factors- Amyloid plaques in the brain, Oxidative stress, neurochemical deficiencies </li></ul>

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ALZHEIMER’S disease <ul><li>CLINCAL MANIFESTATIONS </li></ul><ul><li>1. Forgetfulness </li></ul><ul><li>2. Recent memory loss </li></ul><ul><li>3. Difficulty learning </li></ul><ul><li>4. Deterioration in personal hygiene </li></ul><ul><li>5. Inability to concentrate </li></ul>

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ALZHEIMER’S disease <ul><li>LATE CLINICAL MANIFESTATIONS </li></ul><ul><li>6. Difficulty in abstract thinking </li></ul><ul><li>7. Difficulty communicating </li></ul><ul><li>8. Severe deterioration in memory, language and motor function </li></ul><ul><li>9. repetitive action- perseveration </li></ul><ul><li>10. personality changes </li></ul>

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ALZHEIMER’S disease <ul><li>DIAGNOSTIC TEST </li></ul><ul><li>Neurologic examination </li></ul><ul><li>PET scan </li></ul><ul><li>EEG, CT and MRI </li></ul><ul><li>Other tests to rule out Vit B deficiencies and hypothyroidism </li></ul><ul><li>Autopsy is the most definitive </li></ul>

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ALZHEIMER’S disease <ul><li>Drug therapy </li></ul><ul><li>1. drugs to treat behavioral symptoms- antipsychotics </li></ul><ul><li>2. anxiolytics </li></ul><ul><li>3. Donepezil </li></ul><ul><li>4. Tacrine </li></ul>

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ALZHEIMER’S disease <ul><li>Nursing Interventions </li></ul><ul><li>1. Support patient’s abilities </li></ul><ul><li>2. Provide emotional support </li></ul>

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ALZHEIMER’S disease <ul><li>Nursing Interventions </li></ul><ul><li>3. Establish an effective communication system with the patient and family </li></ul><ul><li>Use short simple sentences, words and gestures </li></ul><ul><li>Maintain a calm and consistent approach </li></ul><ul><li>Attempt to analyze behavior for meaning </li></ul>

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ALZHEIMER’S disease <ul><li>4. protect the patient from injury </li></ul><ul><li>Provide a safe and structured environment </li></ul><ul><li>Requests a family member to accompany client if he wanders around </li></ul><ul><li>Keep bed in low position </li></ul><ul><li>Provide adequate lightning </li></ul><ul><li>Assign consistent caregivers </li></ul>

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ALZHEIMER’S disease <ul><li>5. Encourage exercise to maintain mobility </li></ul>

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PARKINSON’s Disease <ul><li>A slowly progressing neurologic movement disorder </li></ul><ul><li>The degenerative idiopathic form is the most common form </li></ul>

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PARKINSON’s Disease <ul><li>CAUSATIVE FACTORS: unknown </li></ul><ul><li>Potential factors: genetics, atherosclerosis, free radical stress, viral infection, head trauma and environmental factors </li></ul>

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PARKINSON’s Disease <ul><li>Pathophysiology </li></ul><ul><li>Decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia </li></ul><ul><li>Clinical symptoms do not appear until 60% of the neurons have disappeared </li></ul>

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PARKINSON’s Disease <ul><li>CLINICAL MANIFESTATIONS </li></ul><ul><li>1. Tremor- resting, pill-rolling </li></ul><ul><li>2. Rigidity- cog-wheel, lead-pipe </li></ul><ul><li>3. Bradykinesia- abnormally slow movement </li></ul><ul><li>4. Dementia, depression, sleep disturbances and hallucinations </li></ul><ul><li>5. excessive sweating, paroxysmal flushing, orthostatic hypotension </li></ul>

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PARKINSON’s Disease <ul><li>Medical management </li></ul><ul><li>1. Anti-parkinsonian drugs- Levodopa, Carbidopa </li></ul><ul><li>2. Anti-cholinergic therapy </li></ul><ul><li>3. Antiviral therapy- Amantadine </li></ul><ul><li>4. Dopamine Agonists- bromocriptine and Pergolide, Ropirinole anmd Pramipexole </li></ul>

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PARKINSON’s Disease <ul><li>Medical management </li></ul><ul><li>5. MAOI </li></ul><ul><li>6. Anti-depressants </li></ul><ul><li>7. Antihistamine </li></ul>

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PARKINSON’s Disease <ul><li>NURSING INTERVENTIONS </li></ul><ul><li>1. Improve mobility </li></ul><ul><li>2. Enhance Self- care activities </li></ul><ul><li>3. Improve bowel elimination </li></ul><ul><li>4. Improve nutrition </li></ul><ul><li>5. Enhance swallowing </li></ul><ul><li>6. Encourage the use of assistive devices </li></ul>

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PARKINSON’s Disease <ul><li>NURSING INTERVENTIONS </li></ul><ul><li>7. improve communication </li></ul><ul><li>8. Support coping abilities </li></ul>

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EPILEPSY <ul><li>A group of syndromes characterized by recurring seizures </li></ul><ul><li>CAUSES </li></ul><ul><li>1. idiopathic 6. brain tumors </li></ul><ul><li>2. Birth trauma 7. head Injury </li></ul><ul><li>3. perinatal infection 8. metabolic disorders </li></ul><ul><li>4. infectious disease 9. CVA </li></ul><ul><li>5. ingestion of toxins </li></ul>

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EPILEPSY <ul><li>Recurring seizures may be classified as GENERALIZED or PARTIAL SEIZURES </li></ul><ul><li>Generalized Seizures- cause a generalized electrical abnormality within the brain </li></ul><ul><li>Partial seizures- these seizures arise from a localized part of the brain and cause specific symptoms </li></ul>

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GENERALIZED SEIZURES <ul><li>1. General Tonic-Clonic seizure- ( Grand mal ) characterized by loss of consciousness and alternating movements of the extremities </li></ul><ul><li>2. Absence Seizure ( Petit mal )- common in children, begins with a brief change in the LOC, indicated by blinking, rolling of eyes and blank stares </li></ul>

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GENERALIZED SEIZURES <ul><li>3. Myoclonic seizure- characterized by brief, involuntary muscular jerks of body extremities </li></ul><ul><li>4. Akinetic seizure- general loss of postural tone and a temporary loss of consciousness- a drop attack </li></ul>

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PARTIAL SEIZURES <ul><li>1. Simple partial seizure- typically limited to one cerebral hemisphere </li></ul><ul><li>2. Complex partial seizure- begins with an aura, then with impaired consciousness, with purposeless behaviors like lip-smacking, chewing movements </li></ul>

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Epilepsy <ul><li>DIAGNOSTIC TESTS </li></ul><ul><li>1. EEG </li></ul><ul><li>2. CT </li></ul><ul><li>3. MRI </li></ul><ul><li>4. LP </li></ul><ul><li>5. Angiography </li></ul>

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Epilepsy <ul><li>Medical treatment </li></ul><ul><li>1. Anticonvulsants- most commonly phenytoin, phenobarbital and carbamazepine </li></ul><ul><li>Ethosuximide and valproic acid for absence seizure </li></ul><ul><li>2. surgery </li></ul>

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Epilepsy <ul><li>Nursing Intervention </li></ul><ul><li>1. Care of patients during seizure </li></ul><ul><li>2. care of patients after seizures </li></ul><ul><li>3. patient teaching </li></ul>

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BELL’S PALSY <ul><li>Causes </li></ul><ul><li>1. infection </li></ul><ul><li>2. hemorrhage </li></ul><ul><li>3. tumor </li></ul><ul><li>4. local traumatic injury </li></ul>

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BELL’S PALSY <ul><li>MANIFESTATIONS </li></ul><ul><li>1. Unilateral facial weakness </li></ul><ul><li>2. Mouth drooping </li></ul><ul><li>3. Distorted taste perception </li></ul><ul><li>4. Smooth forehead </li></ul><ul><li>5. Inability to close eyelid on the affected side </li></ul><ul><li>6. Incomplete eye closure </li></ul><ul><li>7. excessive tearing when attempting to close the eyes </li></ul><ul><li>8. Inability to raise eyebrows, puff out the cheek </li></ul>

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BELL’S palsy <ul><li>Diagnostic tests </li></ul><ul><li>EMG </li></ul><ul><li>Medical management </li></ul><ul><li>1. Prednisone </li></ul><ul><li>2. Artificial tears </li></ul>

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BELL’S palsy <ul><li>Nursing Interventions </li></ul><ul><li>1. Apply moist heat to reduce pain </li></ul><ul><li>2. Massage the face to maintain muscle tone </li></ul><ul><li>3. Give frequent mouth care </li></ul><ul><li>4. protect the eye with an eye patch. Eyelid can be taped at night </li></ul><ul><li>5. instruct to chew on unaffected side </li></ul>

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Trigeminal neuralgia <ul><li>Also called Tic Douloureux </li></ul><ul><li>Painful disorder that affects one or more branches of the fifth cranial nerve </li></ul><ul><li>CAUSES: repetitive pulsation of an artery as it exits the pons is the usual cause </li></ul>

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Trigeminal neuralgia <ul><li>ASSESSMENT </li></ul><ul><li>1. Pain history </li></ul><ul><li>2. Searing or burning jabs of pain lasting from 1-15 minutes in an area innervated by the trigeminal nerve </li></ul><ul><li>DIAGNOSTIC TESTS Skull x-ray or CT scan </li></ul>

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Trigeminal neuralgia <ul><li>NURSING INTERVENTIONS </li></ul><ul><li>1. provide emotional support </li></ul><ul><li>2. encourage to express feelings </li></ul><ul><li>3. provide adequate nutrition in small frequent meals at room temperature </li></ul>

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Myasthenia gravis <ul><li>A sporadic, but progressive weakness and abnormal fatigability of striated muscles which are exacerbated by exercise and repetitive movements </li></ul>

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Myasthenia gravis <ul><li>ETIOLOGY </li></ul><ul><li>Autoimmune disease </li></ul><ul><li>Thymoma </li></ul><ul><li>Women suffer at an earlier age and are more affected </li></ul>

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Myasthenia gravis <ul><li>Pathophysiology: </li></ul><ul><li>1. Acetylcholine receptor antibodies interfere with impulse transmission </li></ul><ul><li>2. Follows an unpredictable course of periodic exacerbations and remissions </li></ul>

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Myasthenia gravis <ul><li>CAUSE: autoimmune disorder that impairs transmission of nerve impulses </li></ul><ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>Gradually progressive skeletal muscle weakness and fatigue </li></ul><ul><li>Weakness that worsens during the day </li></ul><ul><li>Ptosis, diplopia and weak eye closure </li></ul><ul><li>Blank, mask-like facies </li></ul><ul><li>Difficulty chewing and swallowing </li></ul><ul><li>Respiratory difficulty </li></ul>

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Myasthenia gravis <ul><li>DIAGNOSTIC TESTS </li></ul><ul><li>1. EMG </li></ul><ul><li>2. TENSILON TEST </li></ul><ul><li>3. CT scan </li></ul><ul><li>4. Serum anti-AchReceptor antibodies </li></ul>

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Myasthenia gravis <ul><li>MEDICAL THERAPY </li></ul><ul><li>Anticholinesterase drugs- pyridostigmine and neostigmine </li></ul><ul><li>Corticosteroids </li></ul><ul><li>Immunosuppresants </li></ul><ul><li>Plasmapheresis </li></ul><ul><li>Thymectomy </li></ul>

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Myasthenia gravis <ul><li>NURSING INTERVENTIONS </li></ul><ul><li>1. Administer prescribed medication as scheduled </li></ul><ul><li>2. Prevent problems with chewing and swallowing </li></ul><ul><li>3. Promote respiratory function </li></ul><ul><li>4. Encourage adjustments in lifestyle to prevent fatigue </li></ul><ul><li>5.maximize functional abilities </li></ul>

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Myasthenia gravis <ul><li>6. Prepare for complications like myasthenic crisis and cholinergic crisis </li></ul><ul><li>7. prevent problems associated with impaired vision resulting from ptosis of eyelids </li></ul><ul><li>8. provide client teaching </li></ul><ul><li>9. promote client and family coping </li></ul>

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Meningitis <ul><li>Infection or inflammation of the meninges covering the brain and spinal cord. </li></ul><ul><li>Caused by bacterial, viral and fungal agents </li></ul>

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Brain Abscess <ul><li>A free or encapsulated collection of pus in the brain parenchyma </li></ul><ul><li>Causes: usually secondary to another infection like- sinusitis, meningitis, dental abscess, mastoiditis, bacteremia and trauma </li></ul>

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Encephalitis <ul><li>Intense inflammation of the brain tisssue with lymphocytic infiltration, cerebral edema, degeneration of brain cells and diffuse nerve cell destruction </li></ul>

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CNS infections <ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>Meningitis </li></ul><ul><li>1. fever, headache, vomiting </li></ul><ul><li>2. positive meningeal sings </li></ul><ul><li>Brain abscess </li></ul><ul><li>1. headache, N/V, seizures, changes in LOC </li></ul><ul><li>2. Focal neurologic deficits </li></ul>

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CNS infections <ul><li>DIAGNOSTIC TESTS </li></ul><ul><li>1. CT scan </li></ul><ul><li>2. MRI </li></ul><ul><li>3. EEG </li></ul><ul><li>MEDICAL TREAMENT </li></ul><ul><li>1. Antibiotics </li></ul><ul><li>2. Surgical drainage </li></ul><ul><li>3. Drugs to reduce increased ICP </li></ul>

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CNS infections <ul><li>NURSING INTERVENTIONS </li></ul><ul><li>1. Frequent monitoring of neurologic status </li></ul><ul><li>2. Monitor intake and output </li></ul><ul><li>3. Administer antibiotics </li></ul><ul><li>4. Administer mild laxative to prevent constipation </li></ul><ul><li>5. maintain quiet environment </li></ul>

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Neoplastic diseases <ul><li>A brain tumor is a localized intracranial lesion that occupies space within the skull </li></ul><ul><li>Primary brain tumors originate from cells and structures within the brain. </li></ul>

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Neoplastic disease <ul><li>The cause of brain tumors is unknown </li></ul><ul><li>The only risk factor accepted is radiation exposure to ionization rays </li></ul>

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Neoplastic disease <ul><li>CLINICAL MANIFESTATIONS </li></ul><ul><li>1. increased ICP </li></ul><ul><ul><li>Vomiting </li></ul></ul><ul><ul><li>Headache. Especially early in the morning </li></ul></ul><ul><ul><li>Vomiting </li></ul></ul><ul><ul><li>Visual disturbances </li></ul></ul>

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Neoplastic disease <ul><li>2. Localized symptoms </li></ul><ul><li>Hemiparesis </li></ul><ul><li>Seizures </li></ul><ul><li>Mental status changes </li></ul>

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Neoplastic disease <ul><li>DIAGNOSTIC TESTS </li></ul><ul><li>1. CT scan </li></ul><ul><li>2. MRI </li></ul><ul><li>3. PET </li></ul><ul><li>4. EEG </li></ul>

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Neoplastic disease <ul><li>MEDICAL MANAGEMENT </li></ul><ul><li>Surgery </li></ul><ul><li>Chemotherapy </li></ul><ul><li>Radiotherapy </li></ul>

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Neoplastic disease <ul><li>NURSING INTERVENTIONS </li></ul><ul><li>1. promote self-care independence </li></ul><ul><li>2. improve nutrition </li></ul><ul><li>3. relieve anxiety </li></ul><ul><li>4. enhance family processes </li></ul><ul><li>5. provide pre-operative and post-operative care </li></ul><ul><li>6. manage pain </li></ul>